The Jury's Still Out on Victoza

Written by Amy Tenderich
| Published on April 7, 2010

Novo Nordisk is well-known in the diabetes community for its insulins, Novolog and Levemir, used to treat mainly type 1 diabetes. But in the last year, Novo launched a new kind of injectable, a "first line of defense for people with type 2 diabetes" called Victoza (generic: liraglutide). It's a glucagon-like peptide-1 (GLP-1) drug designed to stimulate insulin secretion when hyperglycemia (high blood sugar) is present.

Victoza is still the new kid on the block here in the US, having just been approved by the FDA on January 25. It was approved in Europe last July, and has already been used by a fair number of patients there.

The big question on the market, and among doctors and patients now is, how will Victoza stack up against Byetta, the most well-known injectable drug for type 2 diabetes? Byetta has been very successful as a weight-loss aid, but the nausea it causes makes it intolerable for some people.

One big difference is that Victoza has a longer half-life, so it can be injected just once a day, at any time. Byetta, by contrast, hast to be taken at every meal.

How Well It Works

Through an online query, I was lucky to hear from Raymond, living with type 2 diabetes in England: "The doctor prescribed Victoza for me on the 6th of February and I have been taking 0.6mg per day at 8am. I have been able to reduce my insulin from 160 units per day to 100."

The side effects, he says, were some nausea and stomach pains which lasted only about a week. "My appetite and hunger has been reduced and I seldom finish my evening meal. Most mornings I have to force myself to eat breakfast but I know I must keep a regular eating pattern. The Victoza I believe has really helped me as I was fast becoming insulin-intolerant."

So what happens when patients combine Victoza with their usual oral anti-diabetes drugs? Funny you should ask. Diabetes Care recently published online the results of the LEADâ„¢ 6 extension study, showing what happens when patients switched from Byetta to Victoza, in addition to the oral drugs. The data showed:

OK, so Victoza received two thumbs up from both Raymond and Diabetes Care — but there are still some concerns. Victoza was given a Black Box warning: "Because of the uncertain relevance of the rodent thyroid C-cell tumor findings to humans, prescribe Victoza only to patients for whom the potential benefits are considered to outweigh the potential risk." Although the marker for thyroid cancer present in patients was high, it was still within normal range, according to the authorities. Still, the only way to find out is to continue ongoing cancer monitoring for the next 15 years (!)

There have also been discussions that drugs like Byetta and Victoza can cause an increased risk of pancreatitis. In response, the drugmakers state: "There is no clear association between this class of drugs with pancreatitis. We know that increased risk of pancreatitis with people with diabetes is three-fold over people without diabetes." So while there is a warning that pancreatitis is also a risk, no clear cause and effect have been proven.

The Business Case

Alan Moses, Chief Global Medical Officer for Novo Nordisk, explains Novo Nordisk's POV on Victoza: "Medications for patients are imperfect at best. They don't treat underlying abnormalities of the disease. There are side effects that are not well perceived by patients: weight gain, hypoglycemia. If patients are already overweight, then gaining weight is the wrong direction. It may further exacerbate their disease state as well. Those issues are some of the reasons why Novo Nordisk decided to pursue this therapeutic area."

So Novo believes that Victoza is a fix for all those problems? Mr. Moses admits that the company also became interested in working on Victoza because their insulin products are predominately used by people with type 2 diabetes later in the course of the disease. Victoza gives Novo an opportunity to start at the diagnosis of type 2 diabetes, hopefully to extend the ability of a person to use their own insulin. "We provide patients with reliable, efficacious products the whole life-cycle of diabetes, " he says.

Who Will Benefit?

My own endo shared her initial thoughts: "I'm trying it on new GLP-1 candidates so I can get some experience with it. I try it especially on people whose fasting blood sugar is higher than I'd like (over 100) since I think it works better on fasting blood sugars, though possibly not as well on postprandial BGs. Need more time to get a real feel for it clinically."

Still new, it may take time before we know how Victoza really works out for people. Anyone out there tried Victoza yet? Or been recommended to do so by your doctor? How have you found it? Please take a moment to share your thoughts in the comments section here.

Disclaimer: Content created by the Diabetes Mine team. For more details click here.

Disclaimer

This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community.
The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines.
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Archived Comments

Hans|2010-04-07

Byetta, Victoza and the weekly candidate in the pipeline mainly restore the incretine effect. That means that they restore the colone hormones' capability to order insulin just in time as new glucose is passed on into the portal vein. And depending on the amount of beta cells left to answer the call postprandial spikes may rise lower. There is no direct effect of Byetta, Victoza & Co. on fasting bgs. But lower postprandial spikes use to make for lower over all bg curves.For people able to read a bit of German here is [url=http://www.onmeda.de/foren/forum-diabetes/%22victoza%22/1699566/read.html]more than[/url] half a year [url=http://www.onmeda.de/foren/forum-diabetes/victoza-%22fortsetzung%2C-2.teil%22/1759510/read.html]of user experience[/url] with [url=http://www.onmeda.de/foren/forum-diabetes/victoza-%22-fortsetzung-teil-iii-%22/1807706/read.html]Victoza & Byetta.[/url]

Corey Ham|2010-04-08

While this medication has been checked and approved by competent persons and the FDA really finds its proper use is welcome, as on many occasions, I have searched somewhere where they ask for my medicine and that spending on prescriptions and doctors more than my medication, and they recommended findyourdrug.com a free form where they have the appropriate medications and appropriate authorization, so it is important for me to know that your opinion of it.

Steve Parker, M.D.|2010-04-08

Just a minor point, but....My understanding is that Byetta is not taken with every meal, but only twice daily, within 60 minutes prior to the meal."With every meal" is technically correct if you just eat twice daily.If all other things were equal, I'd rather inject once instead of twice daily.-Steve

Doug|2010-04-10

Alan Moses is an M.D.

Suzy Smith|2010-04-12

Byetta is twice a day, within 60 minutes of breakfast and dinner. I was on it for awhile, it helped, greatly with my control but, I was having some serious issues with cellulitis in my abdomen (due to a urachal cyst) so I went off of it.

Lori|2010-04-27

My husband was recently prescribed Victoza to replace his Lantis. I have some concern since he had lymphoma cancer in 2002 & 2006. I've read everyting I can find about the cancer warning. Does anyone have any info to share since it has been in use other than the U.S.???

Deacon|2010-05-05

I have just started using this and it is very odd.I am glad that I have the same issues as some of the cases. Just not very hungry anymore and I am a Foodie. I eat very well, work out with a trainer 3 times a week and cook most of my meals and so with my sugar pretty controlled I was put on this. I am amazed at how fast sugars have dropped and I am in the mode of dropping back my Lantus does to counter act the very low sugars in the evenings and mid days.I was taking 120 units of Lantus a day, dropped back to 97 with diet and excercise, and now im at 70 and still changing it to deal with the lows.The stomach problems were a big issue but making my pre bed time "snack" 32 ounces of fresh brewed Green tea and breakfast an egg or two and some Kefir with pro-biotics have stopped the nausea completely.

Melissa Hinckle|2010-05-22

I started taking victoza on 5-14 I have type 2 diabetes. I took lantus 25 mg twice daily. metformin 1000mg twice daily. I have not taken any lantus for 4 days, haven`t needed to. blood sugars between 90-125. no appetite at all!! lost 9 lbs this far. A little nausea but not too bad. I`ve lost my craving for sugar. I will continue this medicine. I`ll keep you posted.

Tonya B.|2010-05-24

I just started Victoza two days ago and the nausea is horrible. Nothing like trying to teach class and having to run out to vomit. I'm taking the lowest dosage as well. I will say though that despite the horrendous nausea and splitting headaches, my blood sugar is the best it's been in ten years. For the first time my waking BS is under 100. I've never been able to do that through diet/exercise or metaformin. I'm just hoping the nausea will eventually go away. I heard from other users it takes a couple of weeks.

Mutaal|2010-06-04

I started taking Victoza about 3 weeks ago. My sugars are much lower than with Byetta, and I am also just not very hungry anymore. However, a few days ago I noticed some large itchy whelts developing at my injection site. I can't find anything about the cause or treatment, does anyone have the same side effect? In the info sheet, it says that side effect occurred in less than .2% of trials, somehow I am always the exception.

Paul Snyder|2010-06-06

I started Victoza 13 april and had some green apple quick step the first few days taking .6 mg. I am now on 1.2 mg and my sugar has been fine. I have reduced my fondness for food & when I do eat it is small portions. In regards to the request by Mutall above, I have had a black & blue spot in the stomach area where I inject but it went away with no other problems

Lisa|2010-06-12

I started Victoza 3 days ago and I love it. My cravings were under control after the very first dose. Lost 4 lbs thus far. I have just a slight nagging nausea that I think I will be able to tolerate even it it never goes away. The main reason I'm Type II is because I am about 75lbs overweight, so whatever weight loss I experience will be a blessing. I can actually say that I feel normal for a change. Before, due to lack of energy, all I did was lie around and wait for something to drag me off the bed. It was a debilitating cycle...eat, get sleepy, lie down, wake up hungry, and start it all over again. Byetta worked for a while, but eventually I wasn't getting the results I started out getting and the injection sites turned into itchy welts that would last for days. So far so good with the Victoza. Good luck everyone.

Denise Parson|2010-06-13

I just started using the Victoza and i love it! I have noticed my appetite has reduced but the fact that I feel GREAT is worth it all! My energy level has gone through the roof! Haven't checked my sugar levels but i know they are down because of the way i feel. I was instructed to start at 0.6 mg for a week and increas to 1.8 mg after that. I hope i feel as good then. No nausea so far, no side effects as of yet.

Tonya B.|2010-06-14

This is my fourth week on Victoza. It has made a huge difference with my blood sugar numbers. They are the best they've been in ten years. However, I have had horrendous nausea, vomiting, headaches, and severe constipation. I started out on .06 for two weeks due to my job plus the nausea. I went up to 1.2 but after five days with side effects becoming even worse, I had to drop back down to .06 because it was unbearable. There was no change in my blood sugar numbers from the .06 to 1.2 dose either. I am down ten pounds but it's been the hard way. I'm also medically hypothyroid after a total thyroidectomy two years ago. I must take thyroid medication daily for the rest of my life. It has been tricking timing that medication so it doesn't cause me severe nausea or vomiting with the Victoza. I have heard that Victoza has a half life of about 12-15 hours. I have found with me it's more like 20.

Selena|2010-06-23

I love Victoza! I just wrote a blog post about it at Oh My Aches and Pains!: http://www.ohmyachesandpains.info/2010/06/ode-to-my-cereal-bowl.html. I have been on it for about two months now and my blood sugar numbers are the best they have been since I was diagnosed with type 2 diabetes 11 years ago. I do have more injection site bruising than I did with Byetta, but nothing horrible. Overall, it is a huge improvement over Byetta, especially with my fasting BG numbers. I almost feel like a normal person now.

Annie|2010-06-24

I started Victoza a month ago and am liking the results. I started on 0.6 for a few weeks, taking it at night to overcome the nausea my endo warned me about. Experienced mild nausea, definite lack of appetite. I lost 90lbs on metformin, diet, and exercise and my endo thought that Victoza would help to jump start my weight loss again because I plateaued with about 15 lbs to go. I have to force myself to eat 3 small meals daily because I rarely feel hungry. I also have to be careful not to eat too much too fast- it leads to feeling extremely full and bloated with major heartburn. I also noticed my frequency of bowel movements has decreased quite a bit. I also have bruising on the tummy injection sites- this seems to go away quicker if you rub on the site vigorously after injecting. I've been on 1.2 for 2 weeks and I've lost 5 pounds. I'm a bit concerned about my bodies reaction after I stop taking it....wondering if the weight will return even though I'm on a pretty strict diet and exercise plan.

Ruth|2010-06-30

I have to agree with Lisa about...I was a sludge. Being 100 pounds overweight, and with uncontrolled sugars (and appetite!) of way over 200 despite Metformin...I felt awful. Despite having an important rewarding job, I was so cloudy mentally in the am with 250 sugars and my appetite so out of control. Being a binge eater, control was really impossible sometimes. But, it was do or die at the doctor's office and I just decided to try the Victoza he was recommending. I'm on my second week and taking the 1.2 dosage. I lost 5 pounds but I have to say I don't know if it was the Victoza or just my desire to become compliant. I have the same appetite as ever (wish that would go!) and I still have binging problems after dinner...but I've quelled most through willpower. It is possible that the Victoza is helping with that. I have a benign thyroid tumor, very small, for 20 years that gets scanned once a year. So I'll be watching as will dr. The only side effect is I get very headachy in the afternoons. I snack appropriately but allthrough the night it's that way. Small price to pay if this all works. I'm buying a treadmill soon, so I'm hoping all that just works to one end: My good health! Good luck everyone.

Vee|2010-07-06

Thank you to all the posters. I just started Victoza today, and will return in a month to update everyone on my progress. I am replacing 2mg of Glucosamine with the Victoza (starting with a .6mg dose. My fasting blood sugars with the Glucosamine average between 100-109. My Dr. recommended the switch because my sugars are in good control but I have about 50 lbs to lose.

beverley cleary|2010-07-06

I've been on Victoza for two weeks now and feel great! No problems so far. I takethe injection in the afternoon. I had much success with Byetta, but after two years my stomach rebelled.

Ruth|2010-07-07

Well, week three completed. No real side effects except transient nausea and headaches almost everyday. But small compared to the low sugars I'm experiencing. I went to eat dinner and I was 112. I was so impressed. i"m still eating a lot and haven't lost more than 6 pounds. I find that I can only eat smaller portions but seem to return to the same meal a half hour later, hungry. I'm just an eater I think. a binge eater. I haven't eating any refined sugar since beginning Victoza...so that alone is a good thing. I try to eat only decent food, but my appetite is as alive as ever. But low sugars are just as important - moreso - than my appetite. I hope for even better results in future weeks. And of course, I pray that I will stay healthy on it and not suffer from any side effects. Best of luck to everyone writing. PLEASE KEEP WRITING...IT HELPS TO HELP OTHERS.Ruth:)

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